Spread the Word: May is #StrokeMonth

Stroke is the fourth leading cause of death and is the number one cause of disability in the United States, and a significant public health problem worldwide. According to the Centers for Disease Control and Prevention (CDC), every year, nearly 800,000 people in the U.S. have a stroke. That’s why organized neurosurgery and AdvaMed have teamed up to get the word out about the signs and symptoms of stroke during May, which is National Stroke Awareness Month. Featured below is an animation we put together in order to help educate the public about stroke. We encourage everyone to join the conversation online by using the hashtag #strokemonth.

Posted in HCSM, Health | Tagged , , , , , |

Ambulatory Surgery Centers Provide Excellent Setting for Spine Surgery

doctors-wohns-largeGuest Post from Richard N.W. Wohns, MD
Associate Clinical Professor of Neurological Surgery
University of Washington
Founder and President, Neospine
Seattle, WA

It is well known that ambulatory surgery centers (ASCs) provide surgical services at costs lower than hospitals — due in large part because ASCs typically limit their procedures to simpler, lower-risk, ambulatory procedures. In a controversial leap forward, starting in 2015, the Centers for Medicare and Medicaid Services (CMS) approved several new spine surgery codes that neurosurgeons can perform at an ASC. These include:

  • Cervical spine fusion
  • Lumbar spine fusion
  • Spine fusion extra segment
  • Cervical spine disc surgery
  • Laminectomy single lumbar
  • Removal of spinal lamina
  • Decompression spinal cord

The result is that many healthy, presumably younger, Medicare patients can opt to have their surgeries at a surgery center, rather than having to go to the hospital. Medicare’s approval of these cases opens the door for more commercial payers to reimburse for these procedures when they are performed at ASCs as well. Some payers in particular regions of the country have been reluctant to approve spine surgery in ASCs — even with available cost effectiveness and quality data — because they base reimbursement on Medicare’s payment policies.

Since 1994, pioneering neurosurgeons gathered and published data on outcomes and cost differentials for spine surgeries in the ASC and hospital, leading a radical change in how nearly all spine care is delivered. Just a few decades ago, the typical patient undergoing removal of a herniated disc (lumbar microdiscectomy) might remain on bed rest for several days and in the hospital for a week or longer. Today, the vast majority of these cases are done on an outpatient basis with a rapid return to normal activity. The recent CMS ruling now makes all the benefits of outpatient spine surgery available to Medicare beneficiaries.

With experience, we anticipate these changes will lead to further efficiencies and quality in neurosurgical interventions. Consider the following:

  • Medicare patients will not be relegated to hospitals and thus will experience fewer surgical infections;
  • The entire healthcare delivery system benefits due to lower cost of spine surgeries, which are increasingly necessary for aging baby-boomers — a  demographic that wants to remain active; and
  • Medicare patients can be operated on in the ASC, without taking up space in the hospital operating room, which blocks access for patients who require a hospital setting for surgery.

As more patients are treated in ASCs, here are a few key trends worth watching in the short and long term:

  • Increased overnight stays at the ASC;
  • Increased need for outpatient rehabilitation or recovery care;
  • More stringent contingency plans for Medicare patients that end up needing a higher-level of care in the hospital; and
  • Further expansion of spine surgery in ASCs.

CMS has finally recognized the safety, improved patient satisfaction, and cost-effectiveness of the ASC setting for spine surgery, which many neurosurgeons have recognize for years.


1. Wohns, RNW: Safety and Cost-Effectiveness of Outpatient Cervical Disc Arthroplasty. Surgical Neurology International, www.surgicalneurologyint.com/content/1/1/77, 2010

Posted in Access to Care, Coding and Reimbursement, Guest Post, Health, Healthcare Costs, Medicare, Patient Safety, Quality Improvement, Spine Care | Tagged , , , , , , |

Senate Finance Health Subcommittee Holds Critical Hearing on Medical Device Tax

222Guest Post from Robert E. Harbaugh, MD, FAANS (left)
AANS President
Hershey, PA
Nathan R. Selden, MD, PhD (right)
CNS President
Portland, Oregon

Today, the Health Subcommittee of the U.S. Senate Committee on Finance held a hearing on the impact of the medical device tax on jobs, innovation and patients. All of organized neurosurgery commends the committee for taking this is a critical step to repealing this detrimental tax.

Created by the Affordable Care Act, the medical device tax is a 2.3 percent excise tax that applies to the gross sales of medical device products. This tax imposes over $30 billion in new taxes and is adversely affecting medical innovation and patient care. In fact, during the hearing, the public heard moving testimony from a cancer patient who explained how this tax could impact access to lifesaving technologies.

It is for this every reason, repealing the medical device tax is among neurosurgery’s top legislative priorities and we applaud the bipartisan efforts of Congress to abolish this arbitrary tax, which is ill-advised and ultimately will negatively impacts our patients.

According to a recent study published by the Advanced Medical Technology Association (AdvaMed), as many as 195,000 jobs may be lost due to the tax, either through layoffs or forgone jobs that would have been created.

Simply put, our healthcare system needs innovation to improve patient care and save lives. Instead, this tax stifles innovation and reduces patient access to new lifesaving technologies. To this end, the AANS and CNS have endorsed both S. 149, the “Medical Device Access and Innovation Protection Act,” and H.R. 160, the “Protect Medical Innovation Act.”

Neurosurgeons stand ready to help repeal this tax and we look forward to working with the members of the Senate Finance Committee and other stakeholders to develop policy solutions to better support medical innovation and increase treatment options for our patients.

Posted in Access to Care, Congress, Guest Post, Health, Health Reform, Healthcare Costs, Medical Innovation | Tagged , , , , , , |